Forskningsläget - Sex Reassignment Surgery/Underlivskirurgi

Inför mitt beslut att göra underlivskirurgi letade jag upp massa science och sammanställde den. Oklart om det faktiskt hjälpte mig något, förutom att tillfredsställa mitt kontrollbehov. Det var definitivt triggande i alla fall, och jag vet fortfarande inte hur operationen går till exakt då jag mådde så illa av att föreställa mig (eller se, för den delen) allt blood and gore.


Outcome of sex reassignment surgery for transsexuals

Three independent reviews of the world literature dealing with the outcome of sex reassignment surgery in transsexualism are presented. In 10-15 % of the patients who undergo sex reassignment the results end up in a failure. There are as many failures in the female to male group as in the male to female group.

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Psychosocial outcomes of sex reassignment surgery

Approximately two-thirds of those undergoing sex-change procedures were improved at follow-up. Females-to-males enjoyed somewhat greater success than males-to-females, almost 10% of whom suffered a serious complication.
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Results were best along the dimensions of cosmetic satisfaction, interpersonal relationships, and psychological well-being. Improvement was less pronounced in the work and economic spheres, the legal arena and, interestingly, in the realm of sexual relations.

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Sexual and Physical Health After Sex Reassignment Surgery

Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
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Relatively few and minor morbidities were observed in our group of patients, and they were mostly
reversible with appropriate treatment.
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The majority of participants reported a change in orgasmic feeling, toward more powerful and shorter for female-to-males and more intense, smoother, and longer in male-to-females.
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After SRS, the transsexual person’s expectations were met at an emotional and
social level, but less so at the physical and sexual level even though a large number of transsexuals
(80%) reported improvement of their sexuality
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Over two-thirds of male-to-females reported the secretion of a vaginal fluid during sexual excitation, originating from the Cowper’s glands, left in place during surgery.
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A total of 5 (9%) out of 55 participants, 3 male-to-females and 2 female-to-males, reported not having any sexual activity. For those who had sexual activity, 30 (60%) participants were very satisfied with their sex life, 18% remained neutral, and 22% were dissatisfied.
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Satisfaction with Surgical Results (%) Breast augmentation Vaginoplasty
Very satisfied                                       66.6                            48.3
Satisfied                                               28.6                            37.9
Neutral                                                 4.8                              10.3
Unsatisfied                                           0                                 0
Very Unsatisfied                                  0.0                              3.4

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Factors Associated with Satisfaction or Regret Following Male-to-Female Sex Reassignment Surgery

Most indicators of transsexual typology, such as age at surgery, previous marriage or parenthood, and sexual orientation, were not significantly associated with subjective outcomes. Compliance with minimum eligibility requirements for SRS specified by the Harry Benjamin International Gender Dysphoria Association was not associated with more favorable subjective outcomes. The physical results of SRS may be more important than preoperative factors such as transsexual typology or compliance with established treatment regimens in predicting postoperative satisfaction or regret.
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Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed  even occasional regret. Forty-one percent of participants rated their Happiness with Result as 10 on 0–10-point scale, and 86% rated it as 8 or higher. Only nine participants (4%) rated their Happiness with Result as ·5, the midscale value. No participants reported consistent Regret, and only 15 participants (6%) were sometimes regretful. All regretful participants provided explanatory comments. Eight regretful participants cited disappointing physical or functional outcomes of surgery as the reason for their regret (e.g., “After losing my clitoris, I entered a deep depression. Feeling is severely diminished.”), while five others cited familial or social problems (e.g., “I miss my family and children. I aman outcast in my family.”).
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Childhood femininity in the participant’s own opinion and age at first wish to change sex were the only preoperative variables related to transsexual typology that showed significant correlations with Absence of Regret; greater childhood femininity and younger age at first wish to change sex were associated with less regret. No preoperative variables associated with compliance with accepted treatment regimens or other preoperative variables showed significant correlations.
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less frequent autogynephilic arousal were associated with greater improvement in quality of life.
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Expert bodies such as the Harry Benjamin International Gender Dysphoria Association may wish to reexamine the value of current minimum eligibility criteria for MtF SRS, assuming that the rationale for such criteria is to minimize the probability of postoperative regret and to maximize the probability of postoperative satisfaction, rather than to create barriers to care.
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Based on the results of this study, a 12-month real-life experience appears to be unnecessary for some applicants for MtF SRS. Some therapists already appear to have reached this conclusion, since 16% of participants in this study reported that they were approved for SRS without having fulfilled this requirement. Since a 12-month minimum real-life experience has never been demonstrated to be associated with more favorable outcomes in a published, peer-reviewed follow-up study (Lawrence, 2001), and because it was not associated with more favorable outcomes in this study, perhaps this requirement should be relaxed until there is empirical evidence demonstrating which, if any,  candidates for MtF SRS it might genuinely benefit.

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Patient-Reported Complications and Functional Outcomes of Male-to-Female Sex Reassignment Surgery

Preoperative electrolysis to remove genital hair, undergone by most patients, was not associated with less serious vaginal hair problems. No patients reported rectal-vaginal fistula or deep-vein thrombosis and reports of other significant surgical complications were uncommon. One third of patients, however, reported urinary stream problems. No single complication was significantly associated with regretting SRS. Satisfaction with most physical and functional outcomes of SRS was high; participants were least satisfied with vaginal lubrication, vaginal touch sensation, and vaginal erotic sensation. Frequency of achieving orgasm after SRS was not significantly associated with most general measures of satisfaction. Later years of surgery, reflecting greater surgeon experience, were not associated with lower prevalence rates for most complications or with better ratings for most physical and functional outcomes of SRS.
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Frequency of achieving orgasm after SRS was not significantly associated with most general measures of satisfaction.
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Pf¨afflin and Junge (1992/1998), in their comprehensive review of SRS outcome studies published between 1961 and 1991, could find no consistent evidence that the quality of surgical results affected patient satisfaction.
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 No participants consistently regretted having undergone SRS and only 15 (6%) participants reported that they were sometimes regretful.
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There was no significant difference in mean rating for vaginal hair problems between participants who had or had not undergone genital electrolysis.
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There were no significant associations between having undergone any other additional surgical procedure and greater overall happiness with genital sexual function, overall happiness with SRS result, or overall improvement in quality of life with SRS.
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vaginal hair and clitoral pain were especially notable: For both items, lower satisfaction ratings were significantly associated with regretting SRS sometimes and with lower ratings on two other overall outcome measures. Lower satisfaction ratings on two urinary problems, urine leakage with cough or strain and bladder infections, were associated with lower ratings on overall happiness with genital sexual function and overall happiness with SRS result. For the remaining six physical and functional outcome categories, nearly all associations were nonsignificant.
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Later years of surgery were significantly associated with fewer instances of vaginal stenosis during sexual arousal and with greater satisfaction with vaginal depth and width, but not with fewer complications of other kinds or with superior outcomes in other physical or functional categories.
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Complications:Vaginal Stenosis (8%): Narrowing of the vagina due to a build-up of scar tissue.
Misdirected urinary stream (33%)
Meatal Stenosis/Uretral Stricture: (9%) A urethral stricture is a narrowing of the urethra, constricting the opening through which urine leaves the body from the urinary bladder.
Clitoral Necrosis (3%): Tissue death
Pain in vagina or genitals (9%)
Compartment Syndrome (1-2%): Compartment syndrome is increased pressure within one of the body's compartments which contains muscles and nerves.
Rectum perforation (1%)
Late onset abscess (1%): A collection of pus that has built up within the tissue of the body.

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Genital Sensitivity After Sex Reassignment Surgery in Transsexual Patients

We also asked the examined patients if they experienced orgasm after surgery, during any sexual practice (ie, we considered only patients who attempted to have orgasm): all female-to-male and 85% of the male-to-female patients reported orgasm.

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Regrets After Sex Reassignment Surgery

Among female-to-male transsexuals after SRS, i.e., in men, no regrets were reported in the author's sample, and in the literature they amount to less than 1%. Among male-to- female transsexuals after SRS, i.e., in women, regrets are reported in 1-1.5%. Poor differential diagnosis, failure to carry out the real-life- test, and poor surgical results seem to be the main reasons behind the regrets reported in the literature. According to three cases observed by the author in addition to personality traits the lack of proper care in treating the patients played a major role.
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Twenty percent of persons in the sample were engaged in lesbian relationships and never used the vagina for intercourse, illustrating that sexual orientation can indirectly affect regret rates when the functional result of SRS is a failure.
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Dissatisfaction and regret after SRS have been reported to be associated with the following factors: age over 30 years at first request for surgery (Lindemalm, K¨orlin, & Uddenberg, 1987; Lundstr¨om & W°alinder, 1985; W°alinder, Lundstr¨om, & Thuwe, 1978); personality disorders, personal and social instability (Bodlund & Kullgren, 1996; Lundstr¨om & W°alinder, 1985; W°alinder et al., 1978); secondary transsexualism (Land´en, W°alinder, Hambert, & Lundstr ¨om, 1998; Lundstr¨om & W°alinder, 1985; S¨orensen, 1981); a heterosexual sexual orientation (Blanchard et al., 1989; Money & Wolff, 1973; W°alinder et al., 1978); poor surgical results (Eldh, Berg, & Gustafsson, 1997; Lawrence, 2003; Lundstr¨om, Pauly, & W°alinder, 1984; Ross & Need, 1989); and poor support from the family (Land´en et al., 1998; W°alinder et al., 1978).

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The outcome of sex reassignment surgery in Belgrade: 32 patients of both sexes

The follow-up period after operation was from 6 months to 4 years, and four aspects of the quality of life were examined: attitude towards the patients' own body, relationships with other people, sexual activity, and occupational functioning. In most transsexuals, the quality of life was improved after surgery inasmuch as these four aspects are concerned. Only a few transsexuals were not satisfied with their life after surgery.
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The outcome of sex-reassignment surgery was better in terms of interpersonal adjustment than in terms of any other parameters. For example, changes in the socioeconomic status after the operation were found.
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We have accepted for sex reassignment homosexual transsexuals only. The main reason for doing so was of a legal and social nature. There is no law in Yugoslavia that regulates sex reassignment issues. Unlike homosexual transsexuals, some heterosexual transsexuals do marry and become parents, and changing sexual identity in heterosexual transsexuals, especially in those with their own families, would expose our pioneering work to harsh public criticism. Under such social and legal circumstances and because of the homosexual transsexuals' more conspicuous cross-gender behavior, subjecting only homosexual transsexuals to sex reassignment was not too socially provocative and was not regarded as socially unacceptable [sic?].
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Among transsexuals who underwent male-to-female surgery, 11 (50%) were satisfied with the way their bodies looked, 7 (32%) were satisfied to some extent, and 4 (18%) were not satisfied.
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Results indicate that after sex reassignment surgery transsexuals are more satisfied with their interpersonal relationships. This finding corresponds to Abramowitz's (1986) conclusion that the greatest improvement after sex reassignment surgery is in the domain of interpersonal communication. Improvements in interpersonal communication, interpersonal relationships, and overall social functioning seem to be related to a greater sense of acceptance, that is, to the observation that persons in the patients' immediate surroundings have less difficulty in accepting them after the surgery.
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Not experiencing orgasm after surgery: 37.5%.

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Sexuality Before and After Male-to-Female Sex Reassignment Surgery

Before SRS, 54% of participants had been predominantly attracted to women and 9% had been predominantly attracted to men. After SRS, these figures were 25% and 34%, respectively.
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85% of participants experienced orgasm at least occasionally after SRS and 55% ejaculated with orgasm.
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Sexual orientation is often considered to be a fundamental and unchangeable aspect of personality in biologic males (Harry, 1984; Pillard & Bailey, 1995); however, studies that have compared sexual orientation before and after SRS have demonstrated a shift toward preference for male partners following SRS.
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In a study that used neovaginal photoplethysmography to study patterns of sexual arousal in MtF transsexuals after SRS, Lawrence, Latty, Chivers, and Bailey (2005) demonstrated that reported changes in sexual orientation after SRS can be inconsistent with observed patterns of physiological arousal.
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It appears to be increasingly common for persons who undergo MtF SRS to have been exclusively or almost exclusively attracted to women before SRS and not to be exclusively attracted to men after SRS.
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The rate of anorgasmia experienced by participants appears comparable to that experienced by natal women: Laumann et al. (1994) found that 24% of natalwomen reported that over the last year there had been a period of several months or more during which they had been unable to achieve orgasm.

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Male-to-Female Sex Reassignment Surgery

The complication rate is low, and most complications can be overcome by adequate correctional interventions.
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Post-operative infections were a rarity in our patients.
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Since 1985, out of 500 operations, about
10%of the complications have been stenosis of
the urinary meatus.
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TABLE 1. Complications in 500 sex reassignment surgeries
Complication n
Stenosis of the meatus 43
Compartment syndrome 6
Rectum perforation 5
Late onset abscess 5
Arm plexus lesion 2
Vaginal contraction 1
Recto-vaginal fistula 1
Torn gastrocnemius muscle 1
Peridural block 1

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Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery
an early Swedish study followed 24 transsexual persons for an average of six years and reported one suicide.[5] A subsequent Swedish study recorded three suicides after sex reassignment surgery of 175 patients.[6] A recent Swedish follow-up study reported no suicides in 60 transsexual patients, but one death due to complications after the sex reassignment surgery.[7] A Danish study reported death by suicide in 3 out of 29 operated male-to-female transsexual persons followed for an average of six years.[8] By contrast, a Belgian study of 107  transsexual persons followed for 4–6 years found no suicides or deaths from other causes.
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A recent systematic review and meta-analysis concluded that approximately 80% reported subjective improvement in terms of gender dysphoria, quality of life, and psychological symptoms, but also that there are studies reporting high psychiatric morbidity and suicide rates after sex reassignment.
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Transsexual individuals were at increased risk of being convicted for any crime or violent crime after sex reassignment (Table 2); this was, however, only significant in the group who underwent sex reassignment before 1989.
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suggests that male-to-females are at higher risk for suicide attempts after sex reassignment, whereas female-to-males maintain a female pattern of suicide attempts after sex reassignment



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